轻中度肾功能损伤成人患者核素测定肾小球滤过率的对比研究

Comparative study of GFR isotopic measurement in adult patients with mild-to-moderate renal impairment

    摘要
  • 摘要:
    目的  探讨99Tcm-二亚乙基三胺五乙酸（DTPA）核素肾动态显像及其双血浆法测定肾小球滤过率（GFR）在轻中度肾功能损伤患者中的评估价值。
    方法  回顾性分析2019年1月至2022年12月黄冈市中心医院收治的87例轻中度肾损伤成人患者，其中男性49例、女性38例，年龄（45.56±11.29）岁。所有患者均行99Tcm-DTPA肾动态显像获得校正后Gate's法测定GFR（记为gGFR），同时行经校正后的2 h和4 h单血浆法，以及双血浆法测定双肾GFR，分别记为GFR2h、GFR4h、dGFR。依据双肾dGFR将患者分为轻度60 ml/（min·1.73 m2）≤dGFR<90 ml/（min·1.73 m2）52例和中度30 ml/（min·1.73 m2）≤dGFR<60 ml/（min·1.73 m2）35例2组。组内和组间的比较采用配对t检验，2种方法间的相关性分析采用Pearson相关性分析。
    结果  轻度组52例患者中，与dGFR（72.33±7.12） ml/（min·1.73 m2）比较，gGFR（78.92±19.56） ml/（min·1.73 m2）、GFR2h（38.87±4.14） ml/（min·1.73 m2）、GFR4h（65.69±4.95） ml/（min·1.73 m2）的差异均有统计学意义（t=−2.84、50.55、20.64，均P<0.05）；相关性r值分别为0.55、0.76、0.99。中度组35例患者中，与dGFR（46.73±8.42） ml/（min·1.73 m2）比较，gGFR（55.71±15.80） ml/（min·1.73 m2）、 GFR2h（26.68±8.15） ml/（min·1.73 m2）、GFR4h（45.47±7.70） ml/（min·1.73 m2）的差异均有统计学意义（t=−3.91、21.67、3.37，均P<0.05）；相关性r值分别为0.51、0.76、0.97。
    结论  轻中度肾功能损伤患者核素GFR测定可获得较好的临床评估价值，其中4 h单血浆法测定GFR较为合适。推荐结合4 h采样单血浆法和肾动态显像肾图评价双肾及分肾功能。

     

    Abstract:
    Objective  To evaluate the utility of glomerular filtration rate (GFR) values derived from 99Tcm-diethyleue-triaminepentaacetic acid (DTPA) radionuclide renal dynamic imaging and dual plasma method in patients with mild-to-moderate renal impairment.
    Methods  A retrospective analysis was conducted on 87 adult patients (49 males and 38 females with an average age of 45.56±11.29 years) with mild-to-moderate renal dysfunction registered in the Nuclear Medicine Department of Huanggang Central Hospital from January 2019 to December 2022. All the patients underwent 99Tcm-DTPA renal dynamic imaging, and their GFRs were determined using the Gate's method and recorded as gGFR after correction. Blood samples at 2 h and 4 h were collected for each patient. Their GFRs were then calculated using single- and dual-plasma sampling methods and denoted as GFR2h, GFR4h, and dGFR. The patients were divided into two groups: 52 cases with mild (60 ml/(min·1.73 m2)≤dGFR<90 ml/(min·1.73 m2)) and 35 cases with moderate (30 ml/(min·1.73 m2)≤dGFR<60 ml/(min·1.73 m2)) groups according to their dGFR. Within-group and between-group comparisons were performed using paired t-tests. The correlation between the two methods was analyzed with Pearson correlation analysis.
    Results  For the 52 patients in the mild group, the dGFR ((72.33±7.12) ml/(min·1.73 m2)) significantly differed from the gGFR ((78.92±19.56) ml/(min·1.73 m2)), GFR2h ((38.87±4.14) ml/(min·1.73 m2)), and GFR4h ((65.69±4.95) ml/(min·1.73 m2)) (t=−2.84, 50.55, 20.64; P<0.05) with correlation r values of 0.55, 0.76, and 0.99, respectively. For the 35 patients in the moderate group, the dGFR ((46.73±8.42) ml/(min·1.73 m2)) significantly differed from the gGFR ((55.71±15.80) ml/(min·1.73 m2)), GFR2h ((26.68±8.15) ml/(min·1.73 m2)), and GFR4h ((45.47±7.70) ml/(min·1.73 m2)) (t=−3.91, 21.67, 3.37; P<0.05) with correlation r values of 0.51, 0.76, and 0.97, respectively.
    Conclusions  GFR measurement using the radionuclide method is valuable in the diagnosis of patients with mild-to-moderate renal dysfunction. GFR4h (GFR at 4 h measured with single-plasma sampling method) is suitable, but GFR2h is not. The combination of 4 h single-plasma sampling method and renal dynamic imaging nephrography is recommended for the evaluation of bilateral and partial kidney function.

     

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